Virtual interviewer prods veterans to reveal post-traumatic stress

(Reuters Health) - Talking – to a computer-generated interviewer named Ellie – appears to free soldiers and veterans who served in war zones to disclose symptoms of post-traumatic stress, a new study finds.

Warriors and veterans were up to three times more likely to reveal symptoms of post-traumatic stress to Ellie, the virtual chatbot, than on an official military survey called the post-deployment health assessment (PDHA), even after being assured the assessment would remain anonymous, researchers report in Frontiers in Robotics and AI.

“We believe this could be of value to veterans,” said study leader Gale Lucas, a research psychologist at the University of Southern California’s Institute for Creative Technologies in Los Angeles. “Having a conversation, even if it’s with a computer, would help them open up and really realize they might be having some issues.”

As many as one in five recent combat veterans develops post-traumatic stress disorder (PTSD), an overactive fear memory that triggers disturbing thoughts, feelings and dreams, according to the U.S. Department of Veterans Affairs.

Stigma around mental health problems frequently prevents soldiers and veterans from admitting symptoms or seeking help, Lucas said in a phone interview.

“Allowing PTSD to go untreated can potentially have disastrous consequences, including suicide attempts,” she said.

Since 2004, suicide rates among active U.S. Army personnel have been rising, but the military’s current PDHA assessment identifies only one in seven soldiers who are considering suicide, previous research has shown.

In an effort to identify early signs of psychological scars, Lucas would like for Ellie, who was developed with U.S. Department of Defense grant money, to be available in kiosks set up in Veterans Administration hospitals throughout the nation.

Ellie starts the conversation with simple questions, such as, ‘Where are you from originally?’ and ‘What do you like to do to relax?’ to develop rapport with soldiers and veterans, Lucas said. Then she asks if they have nightmares, feel on guard or experience other telltale signs of PTSD.

“She’s very nonjudgmental, supportive,” Lucas said.

“We’re not trying to make virtual-agent therapists. She’s not giving treatment. All she’s doing is having a conversation, having them think and open up about the mental health symptoms they might have,” she said.

Prior research has shown that establishing rapport and ensuring anonymity are key to war veterans’ admitting that they are experiencing emotional wounds.

But veterans are hesitant to discuss their psychological suffering with other people, Lucas said.

“If they are talking to a human, they feel judged,” she said. “People feel more comfortable opening up to a computer than a human.”

In two studies, Lucas and her team found that Ellie’s questions prompted soldiers and veterans to open up and reveal more of their mental health needs.

In the first, researchers tested 29 active-duty Colorado National Guard service members returning from Afghanistan.

One of every four service members reported post-traumatic stress symptoms on the official PDHA, and one of three reported symptoms when the questionnaire was made anonymous. In conversations with Ellie, far more – three of four – reported symptoms.

In a second study of 132 active-duty service members and veterans, participants were more than twice as likely to report PTSD symptoms to Ellie than on an anonymous survey.

Alan Peterson, a clinical psychologist and professor at the University of Texas Health Science Center in San Antonio, said fear that service members could lose their jobs often impedes their reporting of psychological symptoms.

“In reality, there can be negative career consequences associated with reporting certain symptoms and behaviors,” said Peterson, who was not involved with the study. “This can be especially true for individuals seeking treatment for conditions such as PTSD, if they are not successfully treated into remission and subsequently determined to be fully fit for military duty.”

Making successful treatments available to soldiers would go a long way to reducing the stigma of seeking psychological help, he said.

“Veterans go through a lot for our country, and I really believe that we should take care of them, not just their physical scars, but their mental scars,” Lucas said.